Sore Throat (Pharyngitis)

What is a sore throat?

When your child complains that his throat is sore, it is usually a symptom of an illness, such as a cold. When you look at the throat with a light, it will be bright red. Children too young to talk may have a sore throat if they refuse to eat or begin to cry during feedings.

What is the cause?

Most sore throats are caused by viruses and are part of a cold. About 10% of sore throats are caused by strep bacteria.

Tonsillitis (temporary swelling and redness of the tonsils) usually occurs with any throat infection, viral or bacterial. Swollen tonsils do not have any special meaning.

Children who sleep with their mouths open often wake up in the morning with a dry mouth and sore throat. It feels better within an hour of having something to drink. Use a humidifier to help prevent this problem.

Children with a postnasal drip from draining sinuses often have a sore throat from the secretions or from clearing their throat often.

How long does it last?

Sore throats caused by viral illnesses usually last 4 or 5 days.

A sore throat caused by Strep will start feeling better soon after being treated with antibiotics. After a child has been taking medicine for strep for 24 hours, strep is no longer contagious. Your child can then return to day care or school if his fever is gone and he's feeling better. Your child must take all of the antibiotic even if he is feeling better. If your child doesn't take all of the medicine, the sore throat could come back.

Why do a rapid Strep test or throat culture?

A throat culture or rapid Strep test is the only way to know whether a sore throat is caused by Strep bacteria or a virus. Without treatment, a strep throat has a small risk for acute rheumatic fever. Rheumatic fever is a complication of strep infections that can lead to permanent damage to the valves of the heart. The Strep test is not urgent, however, since treating a strep infection within 7 days of when it begins can prevent rheumatic fever.

A Strep test is not necessary if your child's sore throat is part of a cold AND the main symptom is croup, hoarseness, or a cough, unless the sore throat lasts more than 5 days.

Rapid strep tests are helpful only when their results are positive. If they are negative, a throat culture is usually performed to pick up the 10% of strep infections that the rapid tests miss. Avoid rapid strep tests performed in shopping malls or at home because they tend to be inaccurate.

How can I take care of my child?

Throat pain relief

Children over age 1 can sip warm chicken broth or apple juice. Children over age 6 can suck on hard candy (butterscotch seems to be a soothing flavor) or lollipops. Children over 8 years old can also gargle with warm salt water (1/4 teaspoon of salt per glass).

Diet

A sore throat can make some foods hard to swallow. Provide your child with a diet of soft foods for a few days if he prefers it. Cold drinks and milkshakes are especially good. Do not give your child salty or spicy foods or citrus fruits.

Fever and pain relief

Give your child acetaminophen (Tylenol) or ibuprofen (Advil) for the sore throat or for a fever over 102°F (39°C).

Common mistakes in treating sore throat

Avoid expensive throat sprays or throat lozenges. Not only are they no more effective than hard candy, but many also contain an ingredient (benzocaine) that may cause an allergic reaction.

Do not use leftover antibiotics from siblings or friends. Leftover antibiotics should be thrown out because they deteriorate faster than other drugs. Also, antibiotics help only strep throats. They have no effect on viruses, and they can cause harm. They also make it difficult to find out what is wrong if your child becomes sicker.

Don't allow anyone to smoke around children.

When should I call my child's healthcare provider?

Call IMMEDIATELY if:

Your child is drooling or having great difficulty swallowing.

Your child is having trouble breathing.

Your child is acting very sick.

Call during office hours:

To make an appointment for a Strep test for any other child who has had a sore throat for more than 48 hours (especially if the child also has a fever without any symptoms of a cold).

Written by Barton D. Schmitt, MD, author of “My Child Is Sick,” American Academy of Pediatrics Books.

This content is reviewed periodically and is subject to change as new health information becomes available. The information is intended to inform and educate and is not a replacement for medical evaluation, advice, diagnosis or treatment by a healthcare professional.